Looking Ahead in 2013 for Home Care and Hospice Providers

The Centers for Medicare & Medicaid (CMS) proposed its Home Health Prospective Payment System (HHPPS) for 2013 and included a number of payment adjustments, reporting requirements and sanctions for noncompliance. In summary, payments made to home health agencies will likely be reduced by approximately 0.1 percent, or $20 million nationally, despite a projected 2.5 percent increase in costs to manage a home healthcare business.    

In the proposal, there are other pending actions that include:

New baseline for Payments:   The baseline for HHA includes price and labor costs. For 2013, CMS proposes to use 2010 historical data to create a new baseline that more accurately reflects HHA costs. Although this new baseline shows 2013 HHA costs will be around 2.5 percent higher than in 2012, the Affordable Care Act (ACA) requires CMS to reduce that number by 1 percentage point for calculating adjustments in payments to HHAs.  

Payments: Case-mix Coding Adjustments. The Medicare payments to HHAs begin with a standard rate for an episode in care or a 60-day period. These standard payments are adjusted for the severity of the patient’s condition and the types of services provided to the patient, and for local and regional differences in wages. The particular combination of services to each patient is reflected in an assigned case-mix code. 

For 2013, CMS proposes to reduce payments further, by 1.32 percent, or $250 million nationally. HHA’s serving rural areas; however, will continue to receive preferential payments 3 percent higher than otherwise due under the proposed PPS rule.  

Hospice Quality Reporting. Beginning Oct. 1, 2013 (or federal fiscal year 2014), the Affordable Care Act requires hospices to report quality data or receive a 2 percent reduction in Medicare payments. The proposed rule requires quality of care data on pain management and on a hospice’s structural capacity to measure quality of care. 

New Hospice Face-to-Face Requirements. Face to face encounters are required when a patient moves from an acute or post-acute facility back to home. The proposed rule requires the physician who was in charge of the inpatient care is to certify the need of home care for the patient with an assessment. A physician or a non-physician healthcare provider working in collaboration with post-acute care providers can conduct the face to face assessment for medical necessity.  

Therapy Coverage and Reassessments.  Every 30 days/ 13th and 19th visits,  a qualified therapist must conduct therapy and an assessment of progress toward specific therapeutic goals. The 2013 rule would continue Medicare coverage of all categories of therapy for which the reassessment was completed on time. The proposed rule also provides greater flexibility by permitting patient reassessment on the 11th, 12th or 13th visit, and on the 17th, 18th or 19th visit.

Compliance Surveys. The rule will continue with the current CMS policies and guidance concerning the frequency and conduct of unannounced on-site standard and compliance surveys.